Evaluation of an interactive case simulation system in dermatology and venereology for medical students

BACKGROUND: Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning. METHODS: Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination. RESULTS: The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination. CONCLUSION: We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination

Pilot field testing of the chronic pain classification for ICD-11: the results of ecological coding

Background: A task force of the International Association for the Study of Pain (IASP) has developed a classification of chronic pain for the ICD-11 consisting of seven major categories. The objective was to test whether the proposed categories were exhaustive and mutually exclusive. In addition, the perceived utility of the diagnoses and the raters’ subjective diagnostic certainty were to be assessed. Methods: Five independent pain centers in three continents coded 507 consecutive patients. The raters received the definitions for the main diagnostic categories of the proposed classification and were asked to allocate diagnostic categories to each patient. In addition, they were asked to indicate how useful they judged the diagnosis to be from 0 (not at all) to 3 (completely) and how confident they were in their category allocation. Results: The two largest groups of patients were coded as either chronic primary pain or chronic secondary musculoskeletal pain. Of the 507 patients coded, 3.0% had chronic pain not fitting any of the proposed categories (97% exhaustiveness), 20.1% received more than one diagnosis. After adjusting for double coding due to technical reasons, 2.0% of cases remained (98% uniqueness). The mean perceived utility was 1.9 ± 1.0, the mean diagnostic confidence was 2.0 ± 1.0. Conclusions: The categories proved exhaustive with few cases being classified as unspecified chronic pain, and they showed themselves to be mutually exclusive. The categories were regarded as useful with particularly high ratings for the newly introduced categories (chronic cancer-related pain among others). The confidence in allocating the diagnoses was good although no training regarding the ICD-11 categories had been possible at this stage of the development

Chronic fatigue syndromes: real illnesses that people can recover from

The ‘Oslo Chronic Fatigue Consortium’ consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation. Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them

Body composition and bone density in children and adolescents. Relation to growth hormone

The regulation of growth, body composition and bone mineralisation during childhood and adolescence is a complex and multifactorial process. Growth hormone (GH) is essential for normal growth; in addition, it influences bone mineralisation and body composition in both children and adults. Leptin is a hormone secreted by adipose tissue which is involved in the regulation of both appetite and energy expenditure. Furthermore, it may also play an important role in hypothalamic-pituitary functions, such as the regulation of GH secretion. Thus, measurements of body composition have become important in clinical endocrinology and endocrine research in order to assess the metabolic effects of hormones and nutritional status on skeletal, adipose and lean tissues. Aim: The general aim of the thesis was to study the relationships among GH secretion, leptin concentration and body composition measured by dual energy X-ray absorptiometry (DXA) and bioelectric impedance (BIA). Furthermore, to evaluate the effect of GH treatment and discontinuation of GH treatment on body composition. Additionally, the aim was to evaluate two different methods for body composition measurements. Results: The main findings from the four papers that form the basis of this thesis are outlined below. Paper I: Seventy-one children were investigated. They were healthy and had different GH secretory capacities before the planned start of GH treatment. Relationships between GH secretion, leptin concentration and body composition, measured by DXA, were studied. A strong positive correlation between leptin levels and body fat, a significant negative correlation between leptin levels and GH secretion, and a significant negative correlation between body fat and GH secretion were found.Paper II: Changes in body composition in relation to changes in leptin concentration were studied during the first year of GH therapy in 33 prepubertal children. Height increased from -2.33 to -1.73 SDS. After 1 year of GH treatment, total body fat decreased by 3%, lean tissue mass increased by 2.9% and total bone mineral density (BMD) increased significantly. Total body BMD SDS was not increased significantly compared with reference values. Serum leptin levels decreased and there was a correlation between the change in body fat and the change in serum leptin levels during the 1 year of GH treatment.Paper III: Forty adolescents treated with GH for more than 3 years and 16 matched controls were studied. The consequences of discontinuing GH treatment on bone mineralisation were examined over a period of 2 years. There were no differences between GH-deficient, GH-sufficient and control subjects either at baseline or after 2 years in bone mineral content (BMC) and BMD measurements. However, biochemical bone markers decreased over the 2 years in the GH treated cohort.Paper IV: Fat-free mass, body fat mass and percentage fat were measured in 61 healthy children to determine the level of agreement between body composition measurements by DXA and single and multifrequency bioelectrical impedance spectroscopy. The estimates were highly correlated between the methods. However, a Bland-Altman comparison showed wide limits of agreement between the methods.Conclusions: The study support the existing evidence for a close correlation between leptin and body fat. Furthermore, the study demonstrate correlations between leptin, body fat and GH secretion. Specific regional fat depots have different relationships with leptin and markers of GH secretion. Leptin may be involved in the hypothalamic regulation of GH secretion. GH treatment affects body composition and bone mineralisation. The present swedish treatment of GH-deficient children to final height results in a normal BMD. Furthermore, DXA and bioelectric impedance methods should not be used interchangeably to measure body composition in children

Lifestyle and nickel allergy in a Swedish adolescent population : effects of piercing, tattooing and orthodontic appliances

The aim of this study was to estimate the prevalence of life-style practices in adolescents and their association with nickel allergy. Upper secondary school pupils (n = 4,376; 15-23 years) were patch-tested for nickel aller-gy, follow-ing completion of a questionnaire (answered by 6,095). Almost 86% girls and 21% of boys reported piercing. More girls (6%) than boys (3%) had a tattoo. Twenty-six percent of the girls and 18% of the boys were regular smokers. Vegetarian/vegan diets were reported by 20% of girls and by 6% of boys. Piercing, female gender, and vocational programme increased the risk of nickel allergy, whereas orthodontic appliance treat-ment prior to piercing reduced the risk of nickel allergy. Pupils in vocational programmes had the highest prevalence of nickel allergy. Lifestyle behaviours are interconnected and cluster in subgroups of adolescents. Female sex, piercing and choice of educational programme are prominent lifestyle markers. A trend shift is observed, where more girls than boys report tattooing

Learning through a virtual patient vs. recorded lecture : a comparison of knowledge retention in a trauma case

Objectives: To compare medical students' and residents' knowledge retention of assessment, diagnosis and treatment procedures, as well as a learning experience, of patients with spinal trauma after training with either a Virtual Patient case or a video-recorded traditional lecture. Methods: A total of 170 volunteers (85 medical students and 85 residents in orthopedic surgery) were randomly allocated (stratified for student/resident and gender) to either a video-recorded standard lecture or a Virtual Patient-based training session where they interactively assessed a clinical case portraying a motorcycle accident. The knowledge retention was assessed by a test immediately following the educational intervention and repeated after a minimum of 2 months. Participants' learning experiences were evaluated with exit questionnaires. A repeated-measures analysis of variance was applied on knowledge scores. A total of 81% (n = 138) of the participants completed both tests. Results: There was a small but significant decline in first and second test results for both groups (F-(1,F-135) = 18.154, p = 0.00). However, no significant differences in short-term and long-term knowledge retention were observed between the two teaching methods. The Virtual Patient group reported higher learning experience levels in engagement, stimulation, general perception, and expectations. Conclusions: Participants' levels engagement were reported in favor of the VP format. Similar knowledge retention was achieved through either a Virtual Patient or a recorded lecture

Effect of Boron on Carbide Coarsening at 873 K (600°C) in 9 to 12 pct Chromium Steels

The addition of small amounts of boron to 9 to 12 pct chromium steels has been found to decrease their creep rate at 823 K to 923 K (550 °C to 650 °C). In this article, the behavior of boron during austenitizing, tempering, and isothermal heat treatment at 873 K (600 °C) is studied using high-resolution microscopy and microanalysis as well as using atomistic modeling. It was found that increasing the boron content from 9 to 40 ppm decreased the coarsening constant of M23C6 by a factor of almost 2. Most of the added boron was incorporated in M23C6. Atomistic modeling showed that boron diffusion in ferrite is dominated by an interstitial mechanism at 873 K (600 °C). However, the generation of vacancies when carbide precipitates dissolve may promote a distribution with substitutional boron atoms. The absence of a fast mechanism for the transition from substitutional to interstitial occupancy will make the slow substitutional boron diffusion in the matrix rate controlling for the coarsening process